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randomised control trial Emergency medicine

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https://www.readbyqxmd.com/read/29678969/reducing-the-default-dispense-quantity-for-new-opioid-analgesic-prescriptions-study-protocol-for-a-cluster-randomised-controlled-trial
#1
Marcus A Bachhuber, Denis Nash, William N Southern, Moonseong Heo, Matthew Berger, Mark Schepis, Chinazo O Cunningham
INTRODUCTION: As opioid analgesic consumption has grown, so have opioid use disorder and opioid-related overdoses. Reducing the quantity of opioid analgesics prescribed for acute non-cancer pain can potentially reduce risks to the individual receiving the prescription and to others who might unintentionally or intentionally consume any leftover tablets. Reducing the default dispense quantity for new opioid analgesic prescriptions in the electronic health record (EHR) is a promising intervention to reduce prescribing...
April 20, 2018: BMJ Open
https://www.readbyqxmd.com/read/29674362/implementation-of-an-evidence-based-model-of-care-for-low-back-pain-in-emergency-departments-protocol-for-the-sydney-health-partners-emergency-department-shaped-trial
#2
Gustavo C Machado, Bethan Richards, Chris Needs, Rachelle Buchbinder, Ian A Harris, Kirsten Howard, Kirsten McCaffery, Laurent Billot, James Edwards, Eileen Rogan, Rochelle Facer, David Lord Cowell, Chris G Maher
INTRODUCTION: Patients with low back pain often seek care in emergency departments, but the problem is that many patients receive unnecessary or ineffective interventions and at the same time miss out on the basics of care, such as advice on self-management. This pattern of care has important consequences for the healthcare system (expensive and inefficient) and for patients (poor health outcomes). We hypothesised that the implementation of an evidence-based model of care for low back pain will improve emergency care by reducing inappropriate overuse of tests and treatments and improving patient outcomes...
April 19, 2018: BMJ Open
https://www.readbyqxmd.com/read/29579763/homeopathy-for-perennial-asthma-in-adolescents-pilot-feasibility-study-testing-a-randomised-withdrawal-design
#3
Livia Mitchiguian Hotta, Ubiratan Cardinalli Adler, Amarilys de Toledo Cesar, Edson Zangiacomi Martinez, Marcelo Marcos Piva Demarzo
INTRODUCTION:  Previous findings from a pragmatic trial suggest that usual care compared with usual care plus individualised homeopathy is not a feasible design to address homeopathic interventions for asthma. OBJECTIVE:  The main purpose of this article was to investigate the feasibility of the randomised withdrawal design as a strategy to assess the effectiveness of a standardised clinical-pharmaceutical homeopathic protocol ( Organon.modus ) on perennial asthma in adolescents...
March 26, 2018: Homeopathy: the Journal of the Faculty of Homeopathy
https://www.readbyqxmd.com/read/29566381/the-research-cycle-improving-care-and-outcomes-for-newborn-infants
#4
William McGuire, Henry L Halliday
Ensuring that policies and practice in perinatal care are informed by evidence from high-quality research is fundamental to improving outcomes for newborn infants and their families. Effective interventions in the perinatal period can have a life-long impact disproportionate to their costs. Many of the major advances in care that have transformed outcomes for preterm and sick newborn infants have been informed by empirical and applied health research. Conversely, there are examples of life-long adverse consequences for infants and families that are a legacy of practices based on poor-quality evidence...
March 22, 2018: Neonatology
https://www.readbyqxmd.com/read/29385990/urox-containing-concentrated-extracts-of-crataeva-nurvala-stem-bark-equisetum-arvense-stem-and-lindera-aggregata-root-in-the-treatment-of-symptoms-of-overactive-bladder-and-urinary-incontinence-a-phase-2-randomised-double-blind-placebo-controlled-trial
#5
RANDOMIZED CONTROLLED TRIAL
Niikee Schoendorfer, Nita Sharp, Tracey Seipel, Alexander G Schauss, Kiran D K Ahuja
BACKGROUND: Storage lower urinary tract symptoms (LUTS) including overactive bladder (OAB) and urinary incontinence (UI) affect millions of people worldwide, significantly impacting quality of life. Plant based medicines have been documented both empirically and in emerging scientific research to have varying benefits in reducing bladder symptoms. We assessed the efficacy of Urox®, a proprietary combination of phytomedicine extracts including, Cratevox™ (Crataeva nurvala) stem bark, Equisetem arvense stem and Lindera aggregata root, in reducing symptoms of OAB and UI...
January 31, 2018: BMC Complementary and Alternative Medicine
https://www.readbyqxmd.com/read/29376560/inotropic-agents-and-vasodilator-strategies-for-the-treatment-of-cardiogenic-shock-or-low-cardiac-output-syndrome
#6
REVIEW
Julia Schumann, Eva C Henrich, Hellen Strobl, Roland Prondzinsky, Sophie Weiche, Holger Thiele, Karl Werdan, Stefan Frantz, Susanne Unverzagt
BACKGROUND: Cardiogenic shock (CS) and low cardiac output syndrome (LCOS) as complications of acute myocardial infarction (AMI), heart failure (HF) or cardiac surgery are life-threatening conditions. While there is a broad body of evidence for the treatment of people with acute coronary syndrome under stable haemodynamic conditions, the treatment strategies for people who become haemodynamically unstable or develop CS remain less clear. We have therefore summarised here the evidence on the treatment of people with CS or LCOS with different inotropic agents and vasodilative drugs...
January 29, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29362276/interdisciplinary-collaboration-across-secondary-and-primary-care-to-improve-medication-safety-in-the-elderly-immense-study-study-protocol-for-a-randomised-controlled-trial
#7
Jeanette Schultz Johansen, Kjerstin Havnes, Kjell H Halvorsen, Stine Haustreis, Lillann Wilsgård Skaue, Elena Kamycheva, Liv Mathiesen, Kirsten K Viktil, Anne Gerd Granås, Beate H Garcia
INTRODUCTION: Drug-related problems (DRPs) are common in the elderly, leading to suboptimal therapy, hospitalisations and increased mortality. The integrated medicines management (IMM) model is a multifactorial interdisciplinary methodology aiming to optimise individual medication therapy throughout the hospital stay. IMM has been shown to reduce readmissions and drug-related hospital readmissions. Using the IMM model as a template, we have designed an intervention aiming both to improve medication safety in hospitals, and communication across the secondary and primary care interface...
January 23, 2018: BMJ Open
https://www.readbyqxmd.com/read/29295790/direct-oral-anticoagulants-an-update
#8
REVIEW
Ana Isabel Franco Moreno, Rosa María Martín Díaz, María José García Navarro
Vitamin K antagonists were the only choice for chronic oral anticoagulation for more than half a century. Over the past few years, direct oral anticoagulants have emerged, including one direct thrombin inhibitor (dabigatran etexilate) and three factor Xa inhibitors (apixaban, edoxaban and rivaroxaban). In randomised controlled trials comparing direct oral anticoagulants with traditional vitamin K antagonists, the direct oral anticoagulants all showed a favourable benefit-risk balance in their safety and efficacy profile, in prevention of thromboembolic events in patients with atrial fibrillation and in the prevention and treatment of venous thromboembolism and acute coronary syndrome...
December 30, 2017: Medicina Clínica
https://www.readbyqxmd.com/read/29248878/systematic-review-and-meta-analysis-of-the-effectiveness-of-pharmacist-led-medication-reconciliation-in-the-community-after-hospital-discharge
#9
Duncan McNab, Paul Bowie, Alastair Ross, Gordon MacWalter, Martin Ryan, Jill Morrison
BACKGROUND: Pharmacists' completion of medication reconciliation in the community after hospital discharge is intended to reduce harm due to prescribed or omitted medication and increase healthcare efficiency, but the effectiveness of this approach is not clear. We systematically review the literature to evaluate intervention effectiveness in terms of discrepancy identification and resolution, clinical relevance of resolved discrepancies and healthcare utilisation, including readmission rates, emergency department attendance and primary care workload...
April 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29214389/using-real-world-data-in-health-technology-assessment-hta-practice-a-comparative-study-of-five-hta-agencies
#10
Amr Makady, Ard van Veelen, Páll Jonsson, Owen Moseley, Anne D'Andon, Anthonius de Boer, Hans Hillege, Olaf Klungel, Wim Goettsch
BACKGROUND: Reimbursement decisions are conventionally based on evidence from randomised controlled trials (RCTs), which often have high internal validity but low external validity. Real-world data (RWD) may provide complimentary evidence for relative effectiveness assessments (REAs) and cost-effectiveness assessments (CEAs). This study examines whether RWD is incorporated in health technology assessment (HTA) of melanoma drugs by European HTA agencies, as well as differences in RWD use between agencies and across time...
March 2018: PharmacoEconomics
https://www.readbyqxmd.com/read/29201367/services-aimed-at-achieving-desirable-clinical-outcomes-in-patients-with-chronic-kidney-disease-and-diabetes-mellitus-a-narrative-review
#11
REVIEW
Fergus William Gardiner, Ezekiel Uba Nwose, Phillip Taderera Bwititi, Judith Crockett, Lexin Wang
There is a large number of patients with chronic kidney disease (CKD), diabetes mellitus (DM), and hypertension (HT) but whether the targets on blood pressure (BP) control in patients with DM and/or CKD are met is not clear. This narrative review therefore investigated evidence on services aimed at achieving desirable clinical results in patients with CKD and DM, and HT in Australia. Literature pertaining to pathology diagnosis and management of these patients as well as the complexities in management were considered...
2017: SAGE Open Medicine
https://www.readbyqxmd.com/read/29196046/prehospital-antibiotics-in-the-ambulance-for-sepsis-a-multicentre-open-label-randomised-trial
#12
Nadia Alam, Erick Oskam, Patricia M Stassen, Pieternel van Exter, Peter M van de Ven, Harm R Haak, Frits Holleman, Arthur van Zanten, Hien van Leeuwen-Nguyen, Victor Bon, Bart A M Duineveld, Rishi S Nannan Panday, Mark H H Kramer, Prabath W B Nanayakkara
BACKGROUND: Emergency medical services (EMS) personnel have already made substantial contributions to improving care for patients with time-dependent illnesses, such as trauma and myocardial infarction. Patients with sepsis could also benefit from timely prehospital care. METHODS: After training EMS personnel in recognising sepsis, we did a randomised controlled open-label trial in ten large regional ambulance services serving 34 secondary and tertiary care hospitals in the Netherlands...
January 2018: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/29192424/interventions-for-old-world-cutaneous-leishmaniasis
#13
REVIEW
Julio Heras-Mosteiro, Begoña Monge-Maillo, Mariona Pinart, Patricia Lopez Pereira, Ludovic Reveiz, Emely Garcia-Carrasco, Pedro Campuzano Cuadrado, Ana Royuela, Irene Mendez Roman, Rogelio López-Vélez
BACKGROUND: Cutaneous leishmaniasis, caused by a parasitic infection, is considered one of the most serious skin diseases in many low- and middle-income countries. Old World cutaneous leishmaniasis (OWCL) is caused by species found in Africa, Asia, the Middle East, the Mediterranean, and India. The most commonly prescribed treatments are antimonials, but other drugs have been used with varying success. As OWCL tends to heal spontaneously, it is necessary to justify the use of systemic and topical treatments...
December 1, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29170309/12-a-multi-centre-randomised-feasibility-study-evaluating-the-impact-of-a-prognostic-model-for-management-of-blunt-chest-wall-trauma-patients-stumbl-trial
#14
Ceri Battle, Hayley Hutchings, Zoe Abbott, Claire O'neill, Sam Groves, Alan Watkins, Fiona Lecky, Sally Jones, James Gagg, Rick Body, Phillip Evans
INTRODUCTION: A new prognostic model has been developed and externally validated, the aim of which is to assist in the management of the blunt chest wall trauma patient in the Emergency Department (ED). A definitive randomised controlled trial (impact trial), is required to assess the clinical and cost effectiveness of the new model, before it can be accepted in clinical practice. The purpose of this trial is to assess the feasibility and acceptability of such a definitive trial and inform its design...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29149474/interventions-for-old-world-cutaneous-leishmaniasis
#15
REVIEW
Julio Heras-Mosteiro, Begoña Monge-Maillo, Mariona Pinart, Patricia Lopez Pereira, Ludovic Reveiz, Emely Garcia-Carrasco, Pedro Campuzano Cuadrado, Ana Royuela, Irene Mendez Roman, Rogelio López-Vélez
BACKGROUND: Cutaneous leishmaniasis, caused by a parasitic infection, is considered one of the most serious skin diseases in many low- and middle-income countries. Old World cutaneous leishmaniasis (OWCL) is caused by species found in Africa, Asia, the Middle East, the Mediterranean, and India. The most commonly prescribed treatments are antimonials, but other drugs have been used with varying success. As OWCL tends to heal spontaneously, it is necessary to justify the use of systemic and topical treatments...
November 17, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29145878/improving-readiness-for-recruitment-through-simulated-trial-activation-the-adjuvant-steroids-in-adults-with-pandemic-influenza-asap-trial
#16
Wei Shen Lim, Garry Meakin, Clare Brittain, Thomas Bewick, Lelia Duley
BACKGROUND: Research in public health emergencies requires trials to be set up in readiness for activation at short notice and in anticipation of limited timelines for patient recruitment. We conducted a simulated activation of a hibernating pandemic influenza clinical trial in order to test trial processes and to determine the value of such simulation in maintaining trial readiness. METHODS: The simulation involved the Nottingham Clinical Trials Unit, one participating hospital, one manufacturing unit and the Investigational Medicinal Product (IMP) supplier...
November 16, 2017: Trials
https://www.readbyqxmd.com/read/29082016/randomised-controlled-trial-of-two-sequential-artemisinin-based-combination-therapy-regimens-to-treat-uncomplicated-falciparum-malaria-in-african-children-a-protocol-to-investigate-safety-efficacy-and-adherence
#17
Henk Dfh Schallig, Halidou Tinto, Patrick Sawa, Harparkash Kaur, Stephan Duparc, Deus S Ishengoma, Pascal Magnussen, Michael Alifrangis, Colin J Sutherland
BACKGROUND: Management of uncomplicated Plasmodium falciparum malaria relies on artemisinin-based combination therapies (ACTs). These highly effective regimens have contributed to reductions in malaria morbidity and mortality. However, artemisinin resistance in Asia and changing parasite susceptibility to ACT in Africa have now been well documented. Strategies that retain current ACT as efficacious treatments are urgently needed. METHODS: We present an open-label, randomised three-arm clinical trial protocol in three African settings representative of varying malaria epidemiology to investigate whether prolonged ACT-based regimens using currently available formulations can eliminate potentially resistant parasites...
2017: BMJ Global Health
https://www.readbyqxmd.com/read/28985255/haloperidol-versus-placebo-for-delirium-prevention-in-acutely-hospitalised-older-at-risk-patients-a-multi-centre-double-blind-randomised-controlled-clinical-trial
#18
Edmée J M Schrijver, Oscar J de Vries, Peter M van de Ven, Pierre M Bet, Ad M Kamper, Sabine H A Diepeveen, Rob J van Marum, Astrid M van Strien, Sander Anten, Anne M Lagaay, Leo Boelaarts, Frank W Bloemers, Mark H H Kramer, Prabath W B Nanayakkara
Background: because the few randomised placebo-controlled trials investigating the potential role for prophylactic haloperidol in delirium prevention have focused on specific surgical populations, we investigated its efficacy and safety in acutely hospitalised older patients. Methods: this multi-centre, double-blind, stratified, block randomised, placebo-controlled trial was conducted at six Dutch hospitals. Patients age ≥70 years, acutely admitted through the emergency department for general medicine or surgical specialties and at risk for delirium were randomised (n = 245) to haloperidol or placebo 1 mg orally twice-daily (maximum of 14 doses) on top of standard nonpharmacological prevention strategies...
January 1, 2018: Age and Ageing
https://www.readbyqxmd.com/read/28956888/the-9-item-physician-documentation-quality-instrument-pdqi-9-score-is-not-useful-in-evaluating-emr-scribe-note-quality-in-emergency-medicine
#19
Katherine J Walker, Andrew Wang, William Dunlop, Hamish Rodda, Michael Ben-Meir, Margaret Staples
BACKGROUND: Scribes are assisting Emergency Physicians by writing their electronic clinical notes at the bedside during consultations. They increase physician productivity and improve their working conditions. The quality of Emergency scribe notes is unevaluated and important to determine. OBJECTIVE: The primary objective of the study was to determine if the quality of Emergency Department scribe notes was equivalent to physician only notes, using the Physician Documentation Quality Instrument, Nine-item tool (PDQI-9)...
September 26, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28946920/role-of-bispectral-index-monitoring-and-burst-suppression-in-prognostication-following-out-of-hospital-cardiac-arrest-a-systematic-review-protocol
#20
Leanne Eveson, Marcela Vizcaychipi, Shashank Patil
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is associated with significant mortality or may have a poor neurological outcome. Various community-training programmes have improved practices like bystander cardiopulmonary resuscitation (CPR) and early defibrillation using automated external defibrillator (AED). Post-resuscitation care has also changed significantly in the millennium. Interventions like targeted temperature management (TTM), avoidance of hyperoxia and emergency cardiac catheterisation have given patients a chance of a better neurological outcome...
September 25, 2017: Systematic Reviews
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